Ahmed A et al. (2006) Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J 27: 178–186
The DIG trial showed that digoxin reduced heart-failure (HF)-related hospitalizations, but not overall mortality, in HF patients with ejection fraction (EF) ≤45%. Low serum digoxin concentrations (SDCs) are associated with reduced mortality, but this correlation has not been demonstrated in patients with EFs >45%. Ahmed et al. investigated the effects of digoxin on all-cause mortality and HF-related hospitalization in HF patients with a range of EFs and SDCs.
This comprehensive post hoc analysis focused on 5,548 DIG trial patients receiving either placebo (n = 3,861) or digoxin at ≤0.125 mg/day, 0.25 mg/day or >0.25 mg/ day. Of the 1,687 digoxin-treated patients for whom data were available, 982 were classified by the authors as having low SDC (0.6–1.2 nM [0.5–0.9 ng/ml]) and 705 were classified as having high SDC (≥1.3 nM [1.0 ng/ml]).
KAPLAN–MEIER ANALYSIS and multivariate analysis showed that, compared with placebo, low SDC was associated with a significantly reduced risk of death (P <0.0001). HF-related hospitalization was significantly less likely in both low and high SDC patients than in placebo patients (P <0.0001 and P = 0.006, respectively); low SDC also reduced risk of all-cause hospitalization (P <0.0001). Factors predicting high SDC included increased age, female sex, diuretic use and digoxin dose ≥0.25 mg/day.
The authors conclude that digoxin, in addition to reducing HF-related hospitalization in chronic HF patients, also reduces all-cause mortality and all-cause hospitalization if given at doses that achieve an SDC of 0.6–1.2 nM. They recommend that digoxin should be used more widely at such doses in HF patients.
About this article
Cite this article
Ireland, R. Relationship between serum digoxin concentration and outcome in chronic heart failure. Nat Rev Cardiol 3, 118 (2006). https://doi.org/10.1038/ncpcardio0464